| NPI | 1972656890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA L MCMANAMON Manager 847-367-4190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021000600) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019012621) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-12-07 |